Cancer Chemotherapy and Pharmacology (2018) 81:573–578
S-1 (Teysuno) and gemcitabine in Caucasian patients
with unresectable pancreatic adenocarcinoma
Stine Braendegaard Winther
· Jon Kroll Bjerregaard
· Katrine Rahbek Schonnemann
Mathilde Weisz Ejlsmark
· Merete Krogh
· Helle Anita Jensen
· Per Pfeier
Received: 3 January 2018 / Accepted: 24 January 2018 / Published online: 31 January 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Gemcitabine has been standard of care in advanced pancreatic adenocarcinomas (PC) for almost two decades.
Randomized, primarily Japanese, studies have shown promising eﬃcacy when combined with S-1 (GemS-1); however, no
data are published in Caucasian patients. We report the ﬁrst study with a combination of GemS-1 in an unselected cohort
of Caucasian PC patients.
Methods In this observational cohort study, we analyzed eﬃcacy and toxicity prospectively.
Results From July 2012 to July 2014, 64 patients received at least one cycle of GemS-1. 16 patients started therapy with
gemcitabine and capecitabine (GemCap) but switched to GemS-1 after median 3 cycles of GemCap due to toxicity (hand-
foot syndrome). 48 patients received GemS-1 as initial therapy. For the complete cohort, median age was 68 years (range
44–80); 22 patients (34%) had locally advanced PC; 42 patients (66%) had metastatic disease. Five patients had received
prior adjuvant therapy with gemcitabine and 9 pts had received prior ﬁrst-line therapy. The most common adverse event was
fatigue (86%), however, only grade 3 in 3%. Five patients (8%) developed febrile neutropenia. Median PFS was 8.1 (95% CI
6.9–9.0) months and median OS was 11.7 (95% CI 10.7–13.1) months in the whole GemS-1 population. In the 48 patients
starting with GemS-1, median PFS was 7.7 (95% CI 6.7–8.9) months and median OS was 11.5 (95% CI 9.7–12.3) months.
Conclusions The combination of gemcitabine and S-1 is safe and associated with promising eﬃcacy in a Caucasian popula-
tion; however, this needs to be conﬁrmed in prospective clinical trials.
Keywords Pancreatic cancer · Gemcitabine · S-1 · Caucasian population
Pancreatic adenocarcinoma (PC) is one of the most fatal
malignancies worldwide. In the European Union (EU),
78,700 new cases were diagnosed in 2012 and with 77,900
deaths PC was the fourth most common cause of cancer-
related death . In Denmark, around 1000 new cases of
PC were diagnosed in 2012 and the incidence is increasing
. For patients with resectable PC, surgery oﬀers a chance
for long-term survival and possible cure; however, less than
15% of all patients are diagnosed with resectable PC , and
unfortunately only 20% of resected patients become long-
term survivors. Thus, more than 90% of patients with PC
will be candidates for palliative chemotherapy during the
course of their disease.
Since 1997, palliative chemotherapy with gemcitabine
as monotherapy has been the accepted standard of care for
advanced PC . During the last decade, numerous gem-
citabine-based combination regimens have been evaluated
in randomized trials, mostly with disappointing results;
however, a meta-analysis has shown longer overall survival
(OS) in patients receiving a combination of gemcitabine
and ﬂuoropyrimidine . Recently, nab-paclitaxel added to
Stine Braendegaard Winther and Jon Kroll Bjerregaard shared ﬁrst
* Stine Braendegaard Winther
Department of Oncology, Odense University Hospital, Sdr.
Boulevard 29, 5000 Odense C, Denmark
Department of Clinical Research, University of Southern
Denmark, Winsløwparken 19, 3. Sal, 5000 Odense C,
Odense Pancreas Center (OPAC), Odense University
Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark